Inaugural tumor-like multiple sclerosis: clinical presentation and medium-term outcome in 87 patients

Area of Science:

• Neurology
• Neuroimmunology
• Radiology

Background:

• Tumefactive demyelinating lesions (TDLs) present as large, focal brain lesions.
• TDLs can be initial manifestations of multiple sclerosis (MS), Balo's concentric sclerosis, Schilder's disease, and acute disseminated encephalomyelitis.
• Overlapping clinical presentations necessitate better characterization of TDL patients.

Purpose of the Study:

• To characterize patients presenting with tumefactive demyelinating lesions as their first neurological event.
• To compare the clinical course of TDLs with classical multiple sclerosis.

Main Methods:

• Retrospective study of 87 patients from French MS centers.
• Inclusion criteria: first clinical event, MRI with large demyelinating lesions (≥20 mm) with mass-like features.
• Exclusion: prior demyelinating events or confirmed MS.

Main Results:

• Mean age at onset was 26 years; 67% presented with hemiparesis/hemiplegia.
• Atypical symptoms (aphasia, headache, cognitive issues) occurred in 15-18% of patients.
• Median follow-up of 5.7 years showed 70% improved or remained stable; 86% received corticosteroids initially.

Conclusions:

• MS presenting with TDLs does not exhibit a different clinical course from classical relapsing-remitting MS.
• Early treatment with corticosteroids and disease-modifying therapies is common.
• The long-term prognosis for TDLs in MS is comparable to typical MS presentations.